Heart Failure Deaths Rising in U.S., Especially Among Younger Adults

By Lisa Rapaport

(Reuters Health) - More U.S. adults are dying from heart failure today than a decade ago, and the sharpest rise in mortality is happening among middle-aged and younger adults, a new study suggests.

Researchers examined data from the U.S. Centers for Disease Control and Prevention (CDC) on deaths from heart failure between 1999 and 2017 among adults 35 to 84 years old.

Between 1999 and 2012, annual heart failure death rates dropped from 78.7 per 100,000 people to 53.7 per 100,000, the researchers found. But then mortality rates started to climb, reaching 59.3 fatalities for every 100,000 people by the end of the study period.

"Up until 2012, we saw decline in cardiovascular deaths in patients with heart failure and this was likely due to advances in medical and surgical treatments for heart failure," said senior study author Dr. Sadiya Khan of Northwestern University Feinberg School of Medicine in Chicago.

"However, this study demonstrates for the first time that the cardiovascular death rate is now increasing in patients with heart failure and this increase is especially concerning for premature death in people under 65," Khan said by email.

About 5.7 million American adults have heart failure, according to the CDC, and about half of the people who develop this condition die within five years of diagnosis.

In the study, African Americans were more likely to die of heart failure than whites, and this disparity was especially pronounced among younger adults, researchers report in the Journal of the American College of Cardiology, May 6.

Compared to white men, black men had a 1.16-fold higher risk of death from heart failure in 1999 but a 1.43-fold higher mortality risk by 2017, the study found.

And, compared to white women, black women started out with a 1.35-fold higher risk of death from heart failure and had a 1.54-fold greater risk by the end of the study period.

When researchers looked just at adults 35 to 64 years old, the racial disparity was even starker: by 2017 black men had a 2.60-fold higher risk of death from heart failure and black women had a 2.97 fold higher risk of death.

"More than 50 percent of black adults have hypertension and have high rates of obesity and diabetes, and this may explain a portion of the disparities in heart failure mortality," Khan said.

"Beyond differences in risk factor prevalence, disparities in access to care unfortunately contribute to both inadequate prevention and diagnosis," Khan added. "We need to do better in terms of access to care for all Americans."

The study used data from the CDC that includes the underlying and contributing cause of death from all death certificates in the U.S. between 1999 to 2017 - for a total of more than 47.7 million people.

The study wasn't designed to determine what might be causing the rise in heart failure deaths.

"Some have speculated this mortality increase has to do with increased prevalence of heart failure risk factors of diabetes and obesity," said Dr. Gregg Fonarow, a cardiologist and researcher at the University of California, Los Angeles, who wasn't involved in the study.

However, it's also possible that a recent shift in Medicare payment rules designed to curb repeat hospitalizations may have "also contributed to the increases in mortality by restricting necessary care, particularly in the most vulnerable heart failure patients," Fonarow said by email.

While black men are more likely to develop heart failure at younger ages, and less likely to receive recommended treatments, they're also more likely to be treated at hospitals that are disproportionately impacted by Medicare efforts to curb repeat hospitalizations, or readmissions, Fonarow said.

"Heart failure is preventable and treatable," Fonarow said. "There is an urgent need . . . to eliminate the healthcare policy that has been associated with the increase in heart failure deaths."

SOURCE: https://bit.ly/2PPYf88

JACC 2019.

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